L_(1～2)椎体压缩性骨折后原有高度的评估

Assessment of the Original Height of L_(1-2) after Vertebral Compression Fracture

目的探索L_(1~2)椎体压缩性骨折后原有高度的评估方法及其在法医临床学鉴定实践中的应用价值。方法收集154例正常人群的胸腰椎侧位X线片,140例作为实验组,14例作为验证组。测量每例X线片中T_(12)~L_3椎体的前缘高度(Ha)、后缘高度(Hp)。实验组中,对Ha_(L1)与Ha_(T12)、Hp_(T12)、Hp_(L1)、Ha_(L2)、Hp_(L2)进行相关性分析,拟合回归方程;对Ha_(L2)与Ha_(L1)、Hp_(L1)、Hp_(L2)、Ha_(L3)、Hp_(L3)进行相关性分析,拟合回归方程。并通过验证组验证Ha_(L1)、Ha_(L2)预测值与实际测量值之间的差异。结果实验组Ha_(L1)(y_1)与Ha_(T12)(x_1)、Ha_(L2)(x_2)相关性较好,多元线性回归方程为:y_1=2.545+0.423 x_1+0.486 x_2(决定系数R^2=0.712,P<0.05;F=169.206,P<0.05)。验证组Ha_(L1)预测值与实际测量值之间的差异无统计学意义(P>0.05)。实验组Ha_(L2)(y_2)与Ha_(L1)(x_3)、Ha_(L3)(x_4)相关性较好,多元线性回归方程为:y_2=4.354+0.530 x_3+0.349 x_4(决定系数R^2=0.689,P<0.05;F=151.575,P<0.05)。验证组Ha_(L2)预测值与实际测量值之间的差异无统计学意义(P>0.05)。结论当L_1或L_2单椎体发生压缩性骨折时,根据压缩椎体上、下相邻椎体的前缘高度来评估压缩椎体的原有高度较为适宜。

Objective To explore the assessment method of original height of L1-2 after vertebral compression fracture and its application value in forensic clinical practice.Methods A total of 154 normal thoracic and lumbar X-ray films were collected,and 140 cases were used as experimental group while 14 cases as validation group.The heights of anterior(Ha)and posterior(Hp)vertebral body of T12-L3 vertebrae in each X-ray image were measured.In the experimental group,the correlation analysis between HaL1 and HaT12,HpT12,HpL1,HaL2 and HpL2 was carried out,and regression equation was established via fitting.The correlation analysis between HaL2 and HaL1,HpL1,HpL2,HaL3,HpL3 was performed,and the regression equation was also established via fitting.The difference between the predicted and measured values of HaL1 and HaL2 in validation group was compared.Results In the 140 normal subjects,HaL1(y1)was well correlated with HaT12(x1)and HaL2(x2),and the multiple linear regression equation was y1=2.545+0.423 x1+0.486 x2(determining coefficient R2=0.712,P<0.05;F=169.206,P<0.05).There was no significant difference between the predicted and actual measured values of HaL1 in the validation group(P>0.05).HaL2(y2)was well correlated with HaL1(x3)and HaL3(x4),and the multiple linear regression equation was y2=4.354+0.530 x3+0.349 x4(determining coefficient R2=0.689,P<0.05;F=151.575,P<0.05).There was no significant difference between the predicted and actual measured values of HaL2 in the validation group(P>0.05).Conclusion It is more appropriate to evaluate the original height of L1 or L2 single vertebrae by comparing with the height of the anterior edge of the upper and lower adjacent vertebral bodies.